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Methanol poisoning: a diagnostic challenge in high anion gap metabolic acidosis

A 47-year-old gentleman was admitted with decreased responsiveness and vomiting. Clinically, he had altered mental status, pupils sluggish to light and laboured breathing. Thoracoabdominal examination and computed tomography of the brain were normal. Preliminary laboratory testing revealed high anio...

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Main Authors: Lai, Yin Ye, Lim, Chee Hoe, C. Thambiah, Subashini, Samsudin, Intan Nureslyna
Format: Article
Language:English
Published: Universiti Putra Malaysia 2023
Online Access:http://psasir.upm.edu.my/id/eprint/108691/1/dokumen/2023122608313314_2023-0670.pdf
http://psasir.upm.edu.my/id/eprint/108691/
https://medic.upm.edu.my/upload/dokumen/2023122608313314_2023-0670.pdf
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spelling my.upm.eprints.1086912024-10-11T08:23:24Z http://psasir.upm.edu.my/id/eprint/108691/ Methanol poisoning: a diagnostic challenge in high anion gap metabolic acidosis Lai, Yin Ye Lim, Chee Hoe C. Thambiah, Subashini Samsudin, Intan Nureslyna A 47-year-old gentleman was admitted with decreased responsiveness and vomiting. Clinically, he had altered mental status, pupils sluggish to light and laboured breathing. Thoracoabdominal examination and computed tomography of the brain were normal. Preliminary laboratory testing revealed high anion gap metabolic acidosis (HAGMA). Blood acetaminophen and urine paraquat were negative. Serum salicylate was not measured however respiratory alkalosis typical of salicylate intoxication was absent. Normoketonaemia and normoglycaemia rendered diabetic ketoacidosis improbable, whilst uraemia was ruled out as renal profile was only moderately impaired. Raised plasma lactate was inadequate to account for the magnitude of HAGMA, leading to a suspicion of ethylene glycol or methanol poisoning. Despite early treatment with intravenous ethanol, the patient died at day three of admission. Blood methanol concentration which was obtained on admission and reported three days later by the referral toxicology lab affirmed the diagnosis of methanol poisoning. Methanol poisoning can be challenging in situations where patient is obtunded and methanol analysis not widely available. Universiti Putra Malaysia 2023-12-16 Article PeerReviewed text en http://psasir.upm.edu.my/id/eprint/108691/1/dokumen/2023122608313314_2023-0670.pdf Lai, Yin Ye and Lim, Chee Hoe and C. Thambiah, Subashini and Samsudin, Intan Nureslyna (2023) Methanol poisoning: a diagnostic challenge in high anion gap metabolic acidosis. Malaysian Journal of Medicine and Health Sciences, 19 (s16). pp. 74-77. ISSN 1675-8544: ESSN: 2636-9346 https://medic.upm.edu.my/upload/dokumen/2023122608313314_2023-0670.pdf 10.47836/mjmhs.19.s16.15
institution Universiti Putra Malaysia
building UPM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Putra Malaysia
content_source UPM Institutional Repository
url_provider http://psasir.upm.edu.my/
language English
description A 47-year-old gentleman was admitted with decreased responsiveness and vomiting. Clinically, he had altered mental status, pupils sluggish to light and laboured breathing. Thoracoabdominal examination and computed tomography of the brain were normal. Preliminary laboratory testing revealed high anion gap metabolic acidosis (HAGMA). Blood acetaminophen and urine paraquat were negative. Serum salicylate was not measured however respiratory alkalosis typical of salicylate intoxication was absent. Normoketonaemia and normoglycaemia rendered diabetic ketoacidosis improbable, whilst uraemia was ruled out as renal profile was only moderately impaired. Raised plasma lactate was inadequate to account for the magnitude of HAGMA, leading to a suspicion of ethylene glycol or methanol poisoning. Despite early treatment with intravenous ethanol, the patient died at day three of admission. Blood methanol concentration which was obtained on admission and reported three days later by the referral toxicology lab affirmed the diagnosis of methanol poisoning. Methanol poisoning can be challenging in situations where patient is obtunded and methanol analysis not widely available.
format Article
author Lai, Yin Ye
Lim, Chee Hoe
C. Thambiah, Subashini
Samsudin, Intan Nureslyna
spellingShingle Lai, Yin Ye
Lim, Chee Hoe
C. Thambiah, Subashini
Samsudin, Intan Nureslyna
Methanol poisoning: a diagnostic challenge in high anion gap metabolic acidosis
author_facet Lai, Yin Ye
Lim, Chee Hoe
C. Thambiah, Subashini
Samsudin, Intan Nureslyna
author_sort Lai, Yin Ye
title Methanol poisoning: a diagnostic challenge in high anion gap metabolic acidosis
title_short Methanol poisoning: a diagnostic challenge in high anion gap metabolic acidosis
title_full Methanol poisoning: a diagnostic challenge in high anion gap metabolic acidosis
title_fullStr Methanol poisoning: a diagnostic challenge in high anion gap metabolic acidosis
title_full_unstemmed Methanol poisoning: a diagnostic challenge in high anion gap metabolic acidosis
title_sort methanol poisoning: a diagnostic challenge in high anion gap metabolic acidosis
publisher Universiti Putra Malaysia
publishDate 2023
url http://psasir.upm.edu.my/id/eprint/108691/1/dokumen/2023122608313314_2023-0670.pdf
http://psasir.upm.edu.my/id/eprint/108691/
https://medic.upm.edu.my/upload/dokumen/2023122608313314_2023-0670.pdf
_version_ 1814054663252606976
score 13.211869

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